At Bayshire Yorba Linda, we recognize how challenging it can be for a family to manage a loved one’s transition to assisted living Fullerton. The move, which already feels overwhelming because of the sense of separation, becomes even more complex as they also need to plan for the costs. One resource available to help offset the cost is Medicare.
Medicare is a federal health insurance program that covers a broad range of medical services needed by seniors. This includes regular doctor appointments, preventive care, and hospitalization expenses. But does Medicare cover assisted living expenses?
Original Medicare doesn’t cover assisted living expenses, including room and board or non-medical daily care (custodial care). But it’s essential to know that it can cover some of the care you receive while living there. This includes standard, medically necessary services like doctor visits, prescription drugs, and physical therapy.
What Is Medicare?
Medicare is a federal health insurance program run by the US government for seniors 65 and older. This program provides health care coverage to over 70.2 million Americans, 90.6% of whom are 65 or older. Medicare covers a wide range of services designed to support one’s health. The exact benefits an older adult receives will depend on the coverage they have chosen.
Reviewing The Different Parts Of Medicare And Whether They Can Help Cover Assisted Living Expenses
Besides choosing the right assisted living community, budgeting is definitely one of the most important things a family has to do. Seniors enrolled in Medicare or about to turn 65 often wonder whether the federal health insurance program can be used to pay for assisted living. They must know that there are four main parts of Medicare: Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage), and Part D (Prescription Drug Coverage). Together, these form a comprehensive system designed to cover different healthcare needs.
Here’s an explanation of the different parts of Medicare and their role in covering assisted living costs.
Original Medicare
Only certain approved services under Original Medicare (Parts A and B), such as hospital stays, doctor visits, medically necessary surgeries, preventive screenings, and durable medical equipment (like wheelchairs or walkers) needed while you live in the community, can be used toward assisted living expenses. However, it doesn’t cover “custodial care,” which includes non-medical help with everyday activities (ADLs) that assisted living provides.
Medicare Advantage (Part C)
Medicare Advantage (Part C) is a Medicare plan offered by private insurance companies that provides your Medicare Part A and Part B coverage. These plans may also include prescription drug (Part D) coverage and certain other benefits. Like Original Medicare, these plans don’t cover assisted living costs; some Part C plans may cover specific non-medical services that assisted living communities typically offer. These include assistance with daily living, meal delivery, and transportation assistance for medical appointments.
Medicare Supplement (Medigap)
It’s a supplemental insurance policy sold by private insurers that helps cover Medicare out-of-pocket costs, such as coinsurance, deductibles, and copayments. Certain Medigap policies also help cover medical services that original Medicare doesn’t cover, such as emergency medical care during overseas travel. However, it’s important to note that it doesn’t pay for assisted living or any other form of long-term care. Still, it might help offset some of the out-of-pocket expenses for short-term care, depending on the specific Medigap plan chosen and its coverage.
Alternatives Available To Manage Assisted Living Costs
For many, managing assisted living costs can be burdensome. In fact, the national median cost of assisted living in the US is approximately $5,500 to $6,200 per month. The base rate typically covers room and board, utilities, meals, housekeeping, and personal care. Here are some options besides Medicare to help manage the overwhelming cost of assisted living.
Medicaid
It can help pay for assisted living if you meet the strict financial requirements (typically an income under $2,982/month) and care-need requirements (nursing home-level care). This assistance is typically provided through HCBS waivers, but it doesn’t cover room and board (rent and meals). However, it may cover personal care (bathing, dressing, eating), medication management, nursing services, and physical therapy.
Veterans’ Benefits
Veterans may be eligible for assisted living benefits through the VA healthcare system. Eligible veterans and surviving spouses will receive tax-free monthly financial benefits that can be used to offset assisted living expenses.
Long-Term Care Insurance
Long-term care policies can be used to cover assisted living costs, depending on the policy and its coverage. It’s important to check with the insurance provider to see what coverage the policy offers.
Private Funds
It’s probably the most commonly used option. Seniors and families may use their income, personal savings, pensions, and other types of private funds to manage assisted living costs.
Bayshire Yorba Linda – Assisted Living That Supports Comprehensive Wellness By Elevating Everyday Wellness
At Bayshire Yorba Linda, we understand how difficult it can be for a family to choose the right assisted living community. They want their loved one to access the best possible care, but covering the costs may be challenging. The above information explains which assisted living-related services Medicare covers and what other payment options are available.
Families looking for a reliable assisted living community for a loved one can contact us at Bayshire Yorba Linda. In our community, we foster a vibrant, upscale lifestyle for residents, helping them lead active, fulfilling lives. With a full and engaging social calendar, residents can experience what community living really means. With restaurant-style meals, engaging activities, and tailored care, we help residents stay healthy and content.
Schedule a tour today to learn more about our premier assisted living community and see whether we’re the right new home for your loved one.
